(Fever Blisters; Herpes Labialis; Herpes Stomatitis; Herpes Simplex)

Definition

Causes

Cold sores are usually caused by the herpes simplex 1 virus. Rarely, cold sores are caused by the herpes 2 virus. The herpes 2 virus causes
genital herpes. The two viruses are related, but different.

In most cases, people contract the virus as young children. The first episode of illness with herpes simplex 1 virus can cause a body-wide illness. After that, the virus lies quietly in the skin until it is reactivated. This is when the virus causes cold sores.

You may get the virus from:

Contact with the fluid from a cold sore of another person, or genital herpes sores

Contact with the eating utensils, razors, towels, or other personal items of a person with active cold sores

Sharing food or drink with a person with active cold sores

Contact with the saliva of a person who has the herpes simplex virus

Risk Factors

Infection with the herpes virus is very common. Everyone is considered at risk for a herpes infection.

If you have a herpes infection, factors that can trigger cold sores include:

Infection, fever, cold, or other illness

Exposure to sun

Physical or emotional stress

Certain drugs

Weakened immune system

Menstruation

Physical injury or trauma

Dental or other oral surgery

Cold sores often form without a known trigger.

Symptoms

The initial herpes simplex 1 infection can cause flu-like symptoms. The recurring infections will result in cold sores.

A cold sore occurs most often on the lips, but can occur in the mouth or other areas of the skin. You may have some symptoms the day just before a cold sore appears. You may notice some itching, tingling, burning, or pain in the area the cold sore appears. Cold sore blisters:

Are small, painful, fluid-filled, red-rimmed blisters

Will dry up with a crust and a shallow sore after a few days

Diagnosis

The doctor will ask about your symptoms and medical history and examine the blisters. Usually, the doctor can easily diagnose a cold sore by looking at it. In rare cases, the doctor may need to take a piece of the blister to be analyzed. A blood sample may also be taken for testing.

Treatment

Cold sores will usually heal within two weeks even without treatment.
However, certain treatments may help decrease symptoms. They may also shorten the time that you have a sore. Treatment options
include:

To reduce pain consider:

Nonprescription cold sore/fever blister cremes and ointments

Putting ice on blisters to lessen pain

Mouthwash with lidocaine—To treat cold sores in the mouth

Medications that may shorten the outbreak include:

Antiviral creams or ointments—May also help decrease pain

Oral antiviral medications—May be given the moment you feel a cold sore coming or can be taken on a regular basis to suppress frequent outbreaks. Examples include:

Acyclovir
(Zovirax)

Valacyclovir
(Valtrex)

Famciclovir
( Famvir)

Avoid rubbing or scratching blisters, which can delay healing. It can also increase your chance of a second infection.

Prevention

To prevent the oral spread of the herpes simplex 1 or 2 virus:

Be careful around people who have active cold sores. Avoid skin contact and kissing. Do not share food, drink, or personal items.

Avoid performing oral sex on a person with active genital herpes.

If you have an active cold sore, avoid touching the infected area. This will help keep you from spreading the virus to other people and/or other parts of your body. If you do touch the area, wash your hands.

The herpes virus will never leave your body once you have it. There is no cure for the infection. If you already have a herpes infection, to prevent future outbreaks of cold sores or blisters:

Avoid long periods of time in the sun.

Use sun block on lips and face when in the sun.

Get adequate rest and relaxation. Try to minimize stress.

If you have outbreaks often, talk to your doctor about taking antiviral medicines.

Herpes. American Academy of Family Physicians. Family Doctor.org website. Available at:
http://familydoctor.org/online/famdocen/home/common/sexinfections/sti/091.html. Updated October 2009. Accessed November 15, 2010.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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